SIXTH ANNUAL REPORT -—— DIVISION OF ANESTHESIA 1943 During 1943, despite fluctuating shortages in the per- sonnel of the medical anesthesia staff, an increased amount of work was performed, and the undergraduate teaching program was enlarged. Approximately 6,300 of the 12,000 anesthesias during the year were administered by this group. This increase of 500 cases over 1942 is due almost entirely to the addition of a third year elective course in anesthesia, of two mon the duration. AGENTS and TECHNICS No new anesthetic agents were forthcoming during 1943, but one drug, curare, has proved to be a valuable adjunct to anesthesia, After several months of preliminary work at the University of Iowa, on the anesthetic use of thie drug, whose only action is to increase akeletal muscle relaxation, its use was begun in this clinic on November 10th. It is remarkable that such a potent drug has so few side effects, other than reepiratory de- pression. In general its use allows a more rapid recovery from inhalation anesthesia, eince deep anesthesia is not necessary for muscular gelaxation for closure of the peritoneum. Several new cafbinations of technics were employed, the most outetanding of these being in the plastic surgery cases, in- volving operations around the head and neck. Several of these patients were intubated with local anesthesia and general anes- thesia accomplished by the use of pentothal intravenously, al- though the duration of anesthesia in some cases was as long as 9 hours. Many more patients in the 1.0.P.H. were anesthetised with pentothal, usually with good results. The lack of an established airway through the larynx in operations about the head was strongly felt in some cases. Anesthesia for suspension laryngoscopies atill proved to be a difficult problem, but seems quite well solved by the use of a topical anesthesia spray, ourere and pento- thal, There is a very narrow margin between the presence of cough reflex, and respiratory arrest from overdose of pentothal. Cyclopropans anesthesia was employed once in October, and once in November for especially poor risk patients, The lack of its availability 4s still badly felt, especially on the urological service, All the anesthesia residents received a period of training in the use of cyclopropane. The Jersey City Wedical Center, Philadelphia General Hospital, and the Albany Hospital cooperated in this respect. RESIDENTS Four residents left the anesthesia service, one for duty in the Armed Forces. Belmont Musicant: Called to active duty in the Army in June, 1943. Commissioned a First Lésutenent. At present is in India with e Portable Surgical Unit. Mary Ward: June 15, 1943. Private practice in Englewood, N.J. Mildred Thompson: July 1, 1943. Director of Anesthesia at the South Baltimore General Hospital. Helene Mayer: Sept. 1, 1943. Director of Anesthesia at the Cambridge Hospital, Cambridge, Mass. Ellen Foot resigned on/t5, 1943 as Instructor in Anes- thesia, and Assistant Anesthetist to become Director of anes- thesia at the New York Hospital—Corneil Hedical Center. Al- though 1t will be impossible to fil her position adequately, we await with interest the development of anesthesia in her new location. Fred Braun was promoted on December 15th from the status of Resident to Assistant Anesthetist, The three former residents now in the army were all elevated to the rank of Captain: Robert Gladstone, Charles Stein and Herman Levin. As an expediency to provide additional personnel, and ae an experiment in teaching, three dental graduates were appoin- ted to the anesthesia ataff as residents. Their work was re- markably good, and two of the three became almost as dependable ae M.D. graduates of similar experience. Since there is no out- let for the dental graduate in the specialty of anesthesia, ex- cept in the armed forces, no other such additions to the staff are contemplated. Dr. Tone Dahl: University of Oslo. Februay 8th to December 1st, Now 4 Lieutenant in the Norwegian Navy. Dr. Glenn Hersey: “ Coluabta University. March let to September lst. NowLiwitenant (j.g.) in the Dental Corps of the U.S. Navy. Dr. Ralph Slater: Columbié University. April let to July Ist. Now Lieutenant (j.g.) in the Dental Corps of the U.S. Navy. Two regular additions to the Anesthesia Staff were made: Helena Bertel: July lst. One year of anesthesia at the Goldwater Memorial Hospitel. Margaret Waldbauers: October lst. One year of anesthesia at the University of Iowa. fwo other physicians epent one month in the departments Edward Edwards: September 14th to October 15th. Los Angeles, Cali. Frank Lushear: November lat to November 30th. Branchville, N.J. It 4a obvinus that wo many changes in the course of one year detract from the quality of the anesthesia service rendered to the patients in this clinic, but the improvement in anesthesia standards in other parte of the country, and in the armed forces seems to us to counterbalance this diffieulty to some extent. RESLDENT TEACHING hesident teaching continued to center about the weekly ataff meetings at 4:00 P.M. on Thursdays, and the bi-monthly meetings on assigned topics, presented by the residents, in preparation for thair American Board of Anesthesiology examinations. The surgical resident teaching decreased somewhat in extent, because of the shortage of personnel on the Surgical Staff. Five residents received instruction in the afternoons for two to four weeke: Hiatt, Tenery, O'Keefe, Bryant and Orr. It ite hoped that the scope of thie teaching will be increased as noon as feasible, for their instruction ia very evident in their future work, afpecially with regard to preoperative preparation and premedication of their patiente. STUDENT TEACHING There were two changes in the teaching schedule for the students. The precperative and postoperative rounds with ‘the Third Year surgical students were discontinued becavee the many frequent changes in the Third Year teaching echedule re- sulted in too great expenditure of time. It was thought more advigable to have Dr. Foot spend her time on the operating floor for the instruction of the students and residente. &4n elective course in anesthesia was offered in May, to Third Year students, for a period of two montha, morning end afternoon. The results were most gratifying. Seven students availed themselves of this opportunity: Nichols, blunt, Howland, MacGregor, Murphy, Steinsieck and Mulliken. Beelides over 500 clinical anesthesiau, each prepared and presented some anesthetic topic, which was diecussed fully. Fourth year teaching continued throughout the year, | eight mornings for each group, and proved to be much less satia- factory than the third year teaching, because of the short period of time. FINANCES A brief financial statement is appended to this report ORS TAFE There were three resignations on the nursing staff, and three new nurse anesthetists were added. Mias Penland and her group have continued to render valuable assistance in these difficult tines, WAR EFFORT Contribution to the war effort was made in several ways31)feven scheduled afternoons were epent with the Army Officers apsigned to the Medical School for their basic training, and with those assigned to the Plastic Surgery specialty. Several other hours were spent with them in the animal surgery labor~ atory demonstrating various technics. . 2) The department cooperated with Dr. Heyman Miller, of the Physiology Departuent and the Fort. Monmouth Signal Corps in studying a problen related te Semperature control and the use of the barbiturates. Several surgical patients anesthetized with pentothal were used for their experimental purposes, and several army volunteers wers anesthetized. The work is being continued, _ 3) Appointment was made to the War-Time Graduate Medical Meetings Committee on Anesthesiology. LECTURES JAnVary .220dsescesceccaccsssencsccsceoes Arwy Lacture February 25theccesccsccrecnessecsecncane F " April Zhe vecncassesvcnrercenerennscsce * . April Rondeccccccceaccccccevvccceecences Yoarly report to Surgical Staff necting July VWAbecccnccenccenssenstnseeesnecasse Third Year Lecture Tale LSthesecceceracesnansenenessesveane Arny Lecture July QBLateescenccescncccvessencesoseoene Third Year Lecture August BObHs cece cenccnvvesnveesreneseven Fourth Year Dental School Lecture ' August {STs sescedevesescnssesocseos. Fourth Year Dental : a Lecture October Tthecscscevcvessencsvesesses Army Lecture October LEthiecssecsssvesccseeeseess Ff November L6thscsseseenscecscsceaeees ® 7 November 23rd.scecscescccensececeeee Third lear Lecture December Tthissscaursscccsssscsvecee ® 8 ® PINGS ATTENDED March...esesess Easton, New England Society of Anesthetiste Paper on "Postoperative Complications* APVAL eo oceseeee Wisconsin, Aqualuant Ways ecoeseoeees Buffalo. New York State Medical Society. Panel discussion on War Anesthesia. MOY cccccsssenss How York. Examiner for dmerican Board of _ Anesthesiology. December....+.. Hartford. Spoke at the Hartford Hospital Anes- thesia Staff meeting. Aleo four meetings of the American Society of Anesthetists, in N.Y. PAPERS PU: Apgar and Foot..«e.. Nelsen's Vol. 1 Loose Leaf Surgery. General Anesthesia. Apgar and Foot..... Second Sd. of "Notes on Anesthesia”. Wboctt,, Hiietlegy andl Apgar onan. TetrachLoretcylene®. 0 2 otis Sobers Apgat..sss Principles of Anesthesia in Plactic Surgery. Surgical Clinies of North America...e. In Press. Rovenstine and Apgar..... Monocaine Spinal Anesthesia. Anesthesiology ..o+. In Press. OTHER ACTIVITLES Duties as Treasurer of the American. Society of Anes~ thetists and a member of the Board of Directors continued. Appoint- was made to a Committee for New Members in the New York County Medical Society, The pocdtion ac attending Anesthetist at Triboro Hospital ecessitated several trips for ancssthesia for chest surgery. A news letter containing information of all past and present members of the department was sent to the seme group in December. Dr. Bllen Foot and Dr. Olgs Schweizer completed their examinations:for the American Board of Anesthesiology. The chief problems of 1944 are again those of too snail a staff to perform the work required, satisfactorily. The Office of Procurement and Assignment has unfortunately reduced the number of allowable residents to three, based on a certain percentage of the 1940 number of ‘revidente, when the department was quite saall. To offset this reduction, the administration has allowed the creation of two new positions, as Junior Anes- ‘thetiste, with the same duties and remuneration as the residents in anesthesia. This will allow ua the eyaivilant of five resi~« | dents and one assistant. Since the proper type of individual to fhli these positions is not immediately available, there are one or two vacancies ahich we hepe to £411 shortly. With the resignation of Dr. Foot, whose invaluable assistance in both the cligical work, and especially the teaching program, is keeniy felt, it is necessary to curtail some of the student instruction in 1944. We have chosen to omit the fourth year groups because of their very short exposure to the subject. The third year elective has been enlarged in scope, and should yield more satisfactory results, both to the students, and to our staff. There is some ray of hope in connection to the future research progran. De. Gregergon has been approached as to the possitility of adding to his staff Major Corsan Reid, whose work in anesthesia and physiology research and whose teaching ability make him an excellent individual to develop anesthesia research 4 _the future, Arrangenents cannot be completed until after the completion of the war, however. once wore, the Division of Anesthesia extends to the Surgical Department and its Direabor, and to the Administrative Offices, ite thaaks for their hearty cooperation throughout 1943. Respectfully submitted, Vass Virginia Apgar, H.D. REPORT on INCOME~—~ if .0, ANESTHESIA DEPARTMENT January February March April May June July August September October November Deceaber 1942-1943 | B2he € 1,980.22 1,306.71 2,650.46 2,221.50 1,980.00 3,012.75 2,356.85 1,916.00 2,304.00 $25,253.00 1343 $ 1,990.56 2,214.46 | 2,770.71 2,115.37 2,488.28 2,575.26 2,833.59 1,751.32 1,650.25 2,155.58 2,235.09 1,834.63 $26,615.10